Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $363.08 / $3,235.94 / $7,585.78	Facility		$363.08	$3,235.94	$7,585.78
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $1,258.93 / $3,162.28 / $5,754.40	Facility	52	$1,258.93	$3,162.28	$5,754.40
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $125.89 / $251.19 / $380.19	Facility	53	$125.89	$251.19	$380.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $363.08 / $1,412.54	Professional		$181.97	$363.08	$1,412.54
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $79.43 / $151.36 / $338.84	Professional	53	$79.43	$151.36	$338.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $316.23 / $380.19	Professional		$169.82	$316.23	$380.19
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $91.20 / $131.83 / $165.96	Professional	53	$91.20	$131.83	$165.96
Cigna Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $741.31 / $1,380.38	Facility		$630.96	$741.31	$1,380.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $426.58 / $891.25	Professional		$229.09	$426.58	$891.25
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $79.43 / $213.80 / $363.08	Professional	53	$79.43	$213.80	$363.08
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $269.15 / $512.86 / $1,023.29	Facility		$269.15	$512.86	$1,023.29
Kaiser Permanente Facility/Professional Facility Modifier 53 Low / Median / High Price $87.10 / $199.53 / $436.52	Facility	53	$87.10	$199.53	$436.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $436.52 / $870.96	Professional		$229.09	$436.52	$870.96
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $87.10 / $190.55 / $380.19	Professional	53	$87.10	$190.55	$380.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $114.82	Professional		$32.36	$33.11	$114.82
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $562.34 / $660.69 / $676.08	Facility		$562.34	$660.69	$676.08
Pacific Source Facility/Professional Facility Modifier 53 Low / Median / High Price $275.42 / $338.84 / $691.83	Facility	53	$275.42	$338.84	$691.83
Pacific Source Facility/Professional Professional Modifier 53 Low / Median / High Price $223.87 / $380.19 / $707.95	Professional	53	$223.87	$380.19	$707.95
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $467.74 / $467.74 / $707.95	Facility		$467.74	$467.74	$707.95
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $467.74 / $851.14	Professional		$257.04	$467.74	$851.14
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,905.46 / $2,570.40 / $4,897.79	Facility		$1,905.46	$2,570.40	$4,897.79
Regence BlueShield Facility/Professional Facility Modifier 53 Low / Median / High Price $1,548.82 / $1,548.82 / $1,548.82	Facility	53	$1,548.82	$1,548.82	$1,548.82
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $478.63 / $758.58	Professional		$288.40	$478.63	$758.58
Regence BlueShield Facility/Professional Professional Modifier 53 Low / Median / High Price $144.54 / $234.42 / $371.54	Professional	53	$144.54	$234.42	$371.54
United Facility/Professional Facility Modifier Low / Median / High Price $933.25 / $3,235.94 / $6,456.54	Facility		$933.25	$3,235.94	$6,456.54
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $380.19 / $676.08	Professional		$213.80	$380.19	$676.08
United Facility/Professional Professional Modifier 53 Low / Median / High Price $218.78 / $218.78 / $218.78	Professional	53	$218.78	$218.78	$218.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $316.23 / $549.54	Professional		$165.96	$316.23	$549.54
Wellpoint Facility/Professional Professional Modifier 53 Low / Median / High Price $83.18 / $158.49 / $275.42	Professional	53	$83.18	$158.49	$275.42